Echo Clarifies Long-Term Risk After Stroke (CME/CE)

By Chris Kaiser, , MedPage TodayPublished: July 01, 2012Reviewed by Robert Jasmer, MD; Associate Clinical Professor of Medicine, University of California, San Francisco

NATIONAL HARBOR, Md. — A easy risk prediction model that uses clinical and echocardiographic characteristics may help identify ischemic stroke patients at a higher risk of future adverse outcomes, researchers found.

Age, chronic renal failure, and the amount of calcification around the aortic root were predictive of death at about 4 years after nonhemorrhagic stroke, Avinash Murthy, MD, from the Albany Medical Center in Albany, N.Y., and colleagues reported.

Researchers assigned 2 points for each decade over 40 years, 11 points for renal failure, and 3 points for aortic root sclerosis.

The high-risk group — more than 11 points — had a mean survival estimate of 39 months, compared with 49 months for the moderate-risk group (5-10 points) and 62 months for the low-risk group (0-5 points), Murthy reported here at the annual meeting of the American Society of Echocardiography (ASE).

The capability of the high-risk score to be predictive of mortality was highly significant at P<0.0001.

There is a conundrum where those with ischemic stroke may also have elevated troponin levels, which could indicate a cardiac event as well, Murthy told MedPage Today.

When clinicians are faced with such patients, they can use the above risk prediction model to determine the patient’s long-term risk. If the patient is at a high risk, based on age, kidney function, and aortic root sclerosis, clinicians then might want to investigate the ischemic burden more intensely, Murthy said.

“We already know that high troponin levels are associated with poor outcomes. However, if patients fall into the low- or intermediate-risk category, it might be prudent to continue with standard stroke care, unless it’s clear they have ECG changes,” he said.

“If they are at a higher risk of poor long-term outcomes and the troponins are elevated, it might be a good idea to see if there is small cardiac insult as well,” he said.

One goal is to draw clinicians’ attention to the possibility that the elevated troponin might not emanate from the brain, he added. “Maybe it’s from the heart and it should be further evaluated. After all, we know that people in this high-risk group do not do well starting at about 2.5 years post-stroke,” he said.

The only risk factors that were independently and strongly associated with increased mortality in the multivariate analysis were:

Age: hazard ratio 1.7 per decade over age 40, 95% CI 1.3 to 2.2 (P<0.001) Renal failure: HR 10.8, 95% CI 2.9 to 40.5 (P<0.001) Aortic root sclerosis: HR 3.1, 95% CI 1.5 to 6.4 (P<0.002)

The investigators also found that a higher hematocrit was “mildly protective” (HR 0.7 per 5 points of hematocrit over 30 mg/dL, 95% CI 0.6 to 0.9, P=0.034).

“Most stroke patients undergo an echocardiography exam at the index admission to look for patent foramen ovale, shunt, or embolus. So data about aortic root sclerosis are already available,” Murthy said. “Now it’s just a matter of combining that information with age and renal function to determine the level of long-term mortality risk.”

Murthy called the results “robust and…practice changing.” His group is now conducting a prospective study of more than 1,000 patients “to make sure the results are true and not a chance finding,” he said.

The researchers reported no conflicts of interest.

Chris has written and edited for medical publications for more than 15 years. As the news editor for a United Business Media journal, he was awarded Best News Section. He has a B.A. from La Salle University and an M.A. from Villanova University. Chris is based outside of Philadelphia and is also involved with the theatre as a writer, director, and occasional actor.

Related News:

• AHA: HDL Boosters Still Promising (CME/CE)
• AHA: Chelation Tx in Post-MI Not Ready Yet (CME/CE)
• Novel Drug Helps Statins Cut Cholesterol (CME/CE)
• Psoriasis Drug Eases Refractory Crohn’s Disease (CME/CE)
• Mom’s Depression Slows Baby’s Development (CME/CE)
• Genes Point to Risk of Finger Disease (CME/CE)
• CJD Dementia Diagnosis Often Delayed (CME/CE)
• CJD Dementia Diagnosis Often Delayed (CME/CE)
• DNA Not Enough to Target HPV as Cancer Culprit (CME/CE)
• DNA Not Enough to Target HPV as Cancer Culprit (CME/CE)

Details :
Submited at Monday, July 2nd, 2012 at 12:15 am on Uncategorized by robert
Comment RSS 2.0 - leave a comment - trackback